133 Pine St. RES19-0080 Repair T1-11 siding 1'x'1fi�» RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH
RES19-0080
�" ISSUED: 3/19/2019
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES: 9/15/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts,state agencies,or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
133 PINE ST RESIDENTIAL ALTERATION REPAIR T1-11 SIDING $6900.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170636 0105 SALTAIR SEC 03
COMPANY: ADDRESS: CITY: 1 STATE: ZIP:
SUPER SIDERS AND TRIM, 65 W. 9th Street Atlantic Beach FL 32233
INC
OWNER: ADDRESS: CITY: ' STATE: ZIP:
STEWART IAN 133 PINE ST ATLANTIC BEACH FL 32233-4011
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $85.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $42.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $131.50
Issued Date:3/19/2019 1 of 2
ro-J-14;. City of Atlantic Beach APPLICATION NUMBER
js •}� Building Department (To be assigned by the Building Department.)
r - $ )� 800 Seminole Road
�., —cc 80
•s Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
-r 9:' E-mail: building-dept@coab.us Date routed: 3 •
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
2.
Property Address: 1 ✓ ��i J ( D ent review required 17 No
Buildi
Applicant: �� U P c— St c&-12... arming &Zoning
Tree Administrator
Project: Rl� c Public Works
� � - � ' J C O (�i Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: pproved. ❑Denied. ['Not applicable
(Circle one.) Comments:
:UILDINe
PLANNING &ZONING � ?
Reviewed by: r//" Date: J 00/7
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ['Denied. ['Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
• rc�Lvr%• Building Permit Application F Updated 10/9/18
,01 ` City of Atlantic Beach Building Department 0 FILE COPT*ALL INFORMATION
°Vr 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
`on 9r IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
l 33 P S IR S1 1 -OC)B
Job Address: � � `�- . / Permit Number: -7 l,�
Legal Description l�-I jp Z!- ZS- Zip:MM/5A 'I i'P' <&. 3' 5# � RE# I 0 6 34o '�O1 t
Valuation of Work(Replacement Cost)$ i/( /!6. 0 Heated/Cooled SF ��` Non-Heated/Cooled
• Class of Work: ❑New ❑Addition 11Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: /7(4) `otts-ew ,
-Peplaci'A bcl 77 // Sfee/W, VA /A, c- 'aJ .
a4rrn-f-dam. •A-P_
Florida Product Approval# for multiple products use product approval form j ,•,-,
Property Owner Information L /- / /G�""E
Name '/ex , /i� ST�G,.e'!r-i Address /55 /4 57~-
City / r!)/ ' State 1L Zip 37723 Phone vv. S7& ' /7'0 t4.9A
E-Mail asJ �, �60e. v r agq _ Cbr✓! /
�Gt
Owner or Agent(If Agent, Power of Attorney g ncy Letter Required)
Contractor Information / -� �/�G . !
Name of Company 5 1 e/ SGerc Q //i�9Qualif�ying A ent `Jf'!l g 1,1 es'
Address 27 (? .)✓1 )i h4— //. City `T44 , State �L Zip _?ZZZS-
Office Phone ft y7 g"- .,g.3. --- Job Site Contact Numb r , ,
State Certification/Registration# /15S- Z4/ E-Mail jet-n.11 i4)s rSs/er54I'/f1 . l'O
Architect Name& Phone# J J U
Engineer's Name&Phone# r= 0
Workers Compensation Insurer .514A 7 OR Exempt❑ Expiration Date 4/
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work o InEialt iq5 has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws egt ag2 Fw-
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBIN , S jNR 0 0
WELLS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirejer 0tFs
permit,there may be additional restrictions applicable to this property that may be found in the public records of this cetlrt,m
there may be additional permits required from other governmental entities such as water management districts,state SeroFiER o)
federal agencies. cc Q Cl) I-
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliancd; ii If,aE V
applicable laws regulating construction and zoning. 0O a wtt $;
CD
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 'VIM W o w
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS. I YO R 'ROPERTY. IF YOU NiE tt
TO OBTAIN FINANCING, CONSULT WITH YOUR LENPEER OR ► ATTORNEY BEFORE 1. w
RECO ING YOUR ICE OE COMMENCEMENT.
v
(Signature of Owner or Agent) (Signature of Con ra •
/4.t. Q
Si ed and sworn to(or affirmed)befor me this day of 'i;�:• an. . orn toii it ed)before me his .. }day of
a.Kt , 2oj c1,by 4I )/ Y..61i,,C (kJVv-f' illiCI L_ 1 ;� .t- =�/, '.
//
l , ig Lure otary) Slgnature .4p: • 6,
4441)f§itlig1049/11111own Notary Public State of Florida
•• OR I Personally Known O' ,, i ..4kzq• •s� TONTGINOLESPERGER
� a..1:oil ;.v.4.1,4,1 .••;*58 [ )Producedldentificat•afk: . : MY COMMISSION;tFFQ94051
aw • . c.ti.n R 0' .''`/r`-_l Type of Identification: 2. mac EXPI c,r ..•._ _ .
'"� '„°L f ` 5cnded Thru Notary Public Ur,
derM;ters
NOTICE OF COMMENCEMENT OFFICE COPY
State of n I,iCJA• Tax Folio No.
County of Uz&VGt.
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved:
Z i Q-Z 5 s4'i i'r"" sem, ? 5-77
Address of property being improved: I S�3 P 54-
General
4General description of improvements: Pe %7-1l n GL,7 k,on —A-0 .6 /, >
Owner: � /1' /� � Address: 3S S . /%7<��l��i� l�C�lt�A z'
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: S41 I!!r— i /llees' an �^/i i_ h� —
Address: / �i]DD,/A7��n Gi it �/�. �J'9-L.
Telephone No.: d y` CX- 3 'cz Fax No:
Surety(if any)
Address: Amount of Bond$ —
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one (1)year from the date of recording unless a different date is
specified): —
.00 Notary Public Slate of Florida
THIS SPACE FOR RECORDER'S USE ONLY •. OWNER 0 T Stacy Moms
My Commbalon`GG •'
Doc#2019053043,OR BK 18712 Page 1893,
Signed: 1 AMPaM1 Expire!• ' (")\ 4
ate
Number Pages:1 rfl"77 7 7
Recorded 03/08/2019 10:29 AM, Before me this ' I ay o Ute. i e ou ty of P uva,State
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Of Florida,has personally appeared
COUNTY Notary Public at Large,State of Florida,County of Duval.
RECORDING $10.00 My commis ".• - sires:
•ersonally Known• or
Pr... .